{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L YMMATNOFAL ","gend":1,"add":"NIAM S 501H TPA TS ","city":"PEARISBURG","state":"VA","zip":"24134-1658","dob":"1968-06-08","age":"","mstatus":"","insh":"50013116","cliId":"","pno":"2767209222","cno":"","email":"","ename":"","eno":"","pphy":"MARTINIUK, KATHERINE E","ppno":5409216110,"pcpadd":"430 BOXWOOD LN,","pcpcity":"Pearisburg","pcpstate":"VA","pcpzip":"24134-1168","pcpcounty":"","pcpid":"","pcpname":"CARILION CLINIC FAMILY MEDICINE GILES RURAL HEALTH","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"105 S MAIN ST APT H","add3":"","madd1":"105 S MAIN ST APT H","madd2":"","madd3":"","mcity":"PEARISBURG","mstate":"VA","mzip":"24134-1658","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","E78.00","Z79.4","F32.9","E11.40","L84","B35.1","N95.1","R68.89","Z12.31","H61.23","M17.0","F33.42","M25.561","R22.41","M23.8X1","M65.9","M25.461","M65.861","M85.661","S83.421A","S83.411A","R93.6","M67.461","M86.18","M86.68","E78.5","E03.9","M19.90","H91.90","K21.9","G89.18","Z01.810","I44.4","R94.31","M85.461","S83.221A","M23.003","M23.000","E04.9","Z23","R63.4","M23.006","M72.2","M89.9","H61.21","M17.12","M25.562","Z12.72","H90.3","Z12.39","R79.89","R59.0","R92.8"],"date":["2023-02-06","2023-02-06","2023-02-06","2023-02-06","2023-04-03","2023-04-03","2023-04-03","2021-01-21","2021-01-21","2023-03-16","2021-03-12","2023-05-25","2022-08-05","2022-05-27","2021-08-23","2021-05-26","2021-05-26","2021-05-26","2021-05-26","2021-06-03","2021-05-26","2021-05-26","2021-05-26","2021-06-08","2021-06-03","2021-06-03","2021-06-03","2021-06-03","2021-06-03","2022-08-05","2021-06-03","2021-06-03","2021-06-03","2021-06-03","2021-06-03","2021-06-08","2021-08-23","2021-08-23","2021-10-25","2022-01-06","2023-02-06","2022-01-21","2022-01-28","2022-05-02","2022-05-27","2022-08-05","2022-08-31","2022-08-31","2023-01-13","2023-02-03","2023-02-06","2023-02-06","2023-03-28","2023-03-28"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","08290320109","BD PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","6","Select","Select",""],["","68180046403","SIMVASTATIN","TAB 40MG","90","Select","Select",""],["","67877056305","METFORMIN","TAB 1000MG","60","Select","Select",""],["","69097015915","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","30","Select","Select",""],["","00093719801","FLUOXETINE","CAP 40MG","90","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","2","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0.25","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}